Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma
Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma
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DOI：
10.1038/sj.bmt.1700900
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发表时间：
1997-09-01
影响因子：
4.8
通讯作者：
Barlogie, B
中科院分区：
文献类型：
--
作者：
Jagannath, S;Vesole, DH;Barlogie, B
本报告总结了2年来在连续251例多发性骨髓瘤患者中进行336例自体移植手术的经验，在串联移植计划中使用200 mg/m2的高剂量美法仑，共有91例患者在门诊接受了118例移植，其余160例患者在住院时接受了218例移植，门诊患者通常更年轻，与住院患者相比，具有更好的干细胞产品、正常的血清白蛋白和β-2-微球蛋白水平以及化疗敏感性疾病，门诊和住院移植受者之间的造血恢复和非血液学毒性没有差异，移植后发热性中性粒细胞减少症和大多数其他移植后毒性在门诊环境中得到成功管理，尽管制定了门诊患者住院的自由标准，包括临床参数以及患者意愿和医生/护士的判断，但只有21%的门诊患者在移植后需要住院。这些门诊患者的平均住院时间为9天，而住院患者的平均住院时间为15天（P = 0.0001），在调整了疾病和宿主特征的差异后，我们的研究显示，门诊管理由于降低了药房（42%）、住院（50%）和病理/实验室费用（36%）而节省了大量资金，我们的结论是，门诊移植应促进获得清髓性治疗，从而提高完全缓解率和生存的骨髓瘤患者。
This report summarizes 2 years experience in performing 336 autotransplant procedures in 251 consecutive patients with multiple myeloma, using high-dose melphalan at 200 mg/m(2) in the context of a tandem transplant program, A total of 91 patients received 118 transplants as outpatients while the remaining 160 patients received 218 transplants as inpatients, Outpatients mere more often younger, with better stem cell products, normal serum albumin and beta-2-microglobulin levels as well as chemotherapy-sensitive disease compared to inpatients, There were no differences in hematopoietic recovery and non-hematologic toxicities between outpatient and inpatient transplant recipients, Post-transplant febrile neutropenia and most other post-transplant toxicities were managed successfully in an ambulatory setting, Although liberal criteria were developed for hospitalization of outpatients, including clinical parameters as well as patient desire and physician/nurse judgment, only 21% of outpatients required admission after transplantation. Median hospital stay for these outpatients,vas 9 days, while inpatients were hospitalized for a median of 15 days (P = 0.0001), After adjusting for differences in disease and host features, our study showed outpatient management resulted in significant financial savings due to lower pharmacy (42%), hospitalization (50%) and pathology/laboratory charges (36%), We conclude that outpatient transplants should facilitate access to myeloablative therapy, thereby improving complete remission rates and survival of myeloma patients.